Key result
Female sex was associated with lower 30-day survival post-SAVR compared to male sex, but mid- to long-term mortality up to 10 years did not differ significantly.
Why the study?
Literature has demonstrated inferior outcomes for women compared with men undergoing heart valve interventions, prompting an analysis of outcomes between men and women undergoing SAVR.
Does female sex impact mortality and postoperative outcomes in adults undergoing surgical aortic valve replacement compared to male sex?
Meta-Analysis
Does female sex impact mortality and postoperative outcomes in adults undergoing surgical aortic valve replacement compared to male sex?
Despite worse 30-day survival, women undergoing SAVR have comparable mid- to long-term mortality to men, with lower rates of aortic valve reoperation and acute kidney injury.
May warrant closer perioperative monitoring for women after SAVR; reinforces equivalent mid- to long-term survival by sex.
AIMS: In recent years, extensive literature has been produced demonstrating inferior outcomes for women when compared with men undergoing heart valve interventions. Herein, we seek to analyze the literature comparing outcomes between men and women undergoing surgical aortic valve replacement (SAVR). METHODS: A systematic literature search of PubMed, MEDLINE, and Embase was conducted for articles comparing differences in outcomes between adult men and women undergoing SAVR. One thousand nine hundred and ninety titles were screened, of which 75 full texts were reviewed, and a total of 19 manuscripts met the inclusion criteria and were included in this review. RESULTS: Pooled estimates of mortality demonstrated that women tended to have lower rates of survival within the first 30 days post-SAVR, although mid-term and long-term mortality did not differ significantly up to 10 years postoperatively. Pooled estimates of postoperative data indicated no difference in the rates of stroke and postoperative bleeding. Rates of aortic valve reoperation and acute kidney injury favored women. CONCLUSION: Despite the inferior outcomes for women post-SAVR that have been reported in recent years, the results of this meta-analysis demonstrate comparable results between the sexes with comparable mid- to long-term mortality in data pooled from the literature. Although mortality favored men in the short term, rates of aortic valve reoperation and acute kidney injury favored women. Future investigation into this field should focus on identifying discrepancies in diagnosis and initial surgical management in order to address any potential factors contributing to discrepant short-term outcomes.
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EL‐Andari et al. (2024) conducted a meta-analysis in Surgical aortic valve replacement (SAVR). Female sex vs. Male sex was evaluated on Mortality (short-term, mid-term, and long-term). Female sex was associated with lower 30-day survival post-SAVR compared to male sex, but mid- to long-term mortality up to 10 years did not differ significantly.
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